Vestibular schwannoma microsurgery with special reference to facial nerve preservation.
OBJECTIVE
To retrospectively study the outcomes of vestibular schwannoma (VS) resection.


METHODS
Between January 2003 and December 2006, 103 consecutive patients who had undergone VS resection were included in this study. Medical records, operation summaries, follow-up data, and neuroradiological findings were analyzed. The relationship between tumor size, location, and topography relative to the facial nerve bundles was studied for a mean duration of 16 months (range: 3-39 months).


RESULTS
Complete tumor resection in combination with anatomic preservation of the facial nerve was achieved in 101 (98.1%) cases. The facial nerve was fully preserved in 100% of cases with small or medium tumors and in 37/39 patients with large tumors. Overall, 83.5% of patients had normal or near-normal facial nerve function 3-12 months post-surgically. The mortality rate was 0%.


CONCLUSIONS
Even in large VS, preservation of facial nerve function (H-B Grade I or II) should be prioritized over total resection. For tumors >3cm, the goal of low morbidity and maintenance of normal facial nerve function can be attained with the retrosigmoid transmeatal approach, refined microsurgical technique, and intraoperative facial nerve monitoring.
Chen
Lihua
L
Department of Neurosurgery, Xuanwu Hospital, The Capital Medical University, China International Neuroscience Institute, Beijing, China. chlyz34@163.com
Chen
Ling
L
Liu
Lixu
L
Ling
Feng
F
Yuan
Xianrui
X
Fang
Jiasheng
J
Liu
Yunsheng
Y
D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone / Q000379:methods; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005154:Facial Nerve / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009464:Neuroma, Acoustic / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D020127:Recovery of Function; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult